Physician survey on pre-/postprocedure measures for injectable treatments.

INTRODUCTION: Every year in the United States, over 1 billion dollars are spent on aesthetic injectables, such as soft tissue fillers and neurotoxins. In 2018, the total amount of injectable treatments performed surpassed 2 671 130 procedures. While often mild and transient, adverse events (AEs) can occur following these procedures. AEs may include common side effects such as bruising, or rare, but serious AEs such as infections. While previous investigators have evaluated methods of reducing risks of AEs due to the treatment procedure itself, few investigations have evaluated measures employed before and/or after treatment (ie, peri-procedure). METHODS: An electronic survey was sent to aesthetic clinicians with experience performing injectable treatments. The survey collected information regarding general information (eg, demographics and specialty), type of injectable devices used, current peri-procedures, and an exploration of future options for peri-procedural measures. RESULTS: Most aesthetic clinicians did not use prophylactic topical or systemic antimicrobials, nor prophylactic topical antiviral therapy. However, approximately 65% of clinicians reported using prophylactic systemic antivirals for patients with a history of herpes simplex virus. A variety of products were used to prepare the skin prior to injectable procedures. Postprocedure, multiple over-the-counter wound repair products were recommended by >70% of injectors. However, there was a large variety of products recommended with no majority consensus. CONCLUSIONS: Currently, there are no peri-procedural standards of practice when performing aesthetic injectable treatments. Efforts are underway for the development of best-practice algorithms.

Pre-/postprocedure measures for minimally invasive, nonenergy aesthetic treatments: A survey.

BACKGROUND: Non-energy based devices used in aesthetic medicine include treatments such as microdermabrasion, microneedling, threads, and chemical peels. Practitioners may use these devices to address signs of facial photo- and chronological aging (fine lines, wrinkles, pigmentary, and skin textural changes). Currently, consensus papers or guidelines are lacking in peri-procedural measures or their potential role in the prevention or treatment of adverse events in non-energy based aesthetic procedures. AIMS: To explore current practices using non-energy devices, a survey was developed to identify trends in peri-procedure treatment measures. PATIENTS/METHODS: The survey was sent electronically to 2000 dermatologists and 388 plastic surgeons. Randomly selected sites included those practicing medical aesthetics using non-energy devices for facial rejuvenation. The survey gathered information related to practitioner demographics, types of devices used, and peri-procedural measures for non-energy device-based treatments. RESULTS: The survey was active from February to May 2019. Nine hundred and twenty clinicians opened the survey, and 109 surveys were completed, providing a total response rate of 11.8%. The results revealed inconsistencies with regards to skin preparation strategies and post-procedure care. While the majority of clinicians indicated a need for topical treatments to reduce inflammation, prevent scarring, and shorten time to healing, a standard of care was not observed. CONCLUSIONS: The results of this survey confirm a lack of standardized measures for peri-procedural care when using non-energy based devices for aesthetic medicine treatments. These findings emphasize the need for evidence-based recommendations for optimizing patient outcomes, reducing and managing adverse events, and shortening time to healing.

Pre-/postprocedure measures for laser/energy treatments: A survey.

BACKGROUND: Laser and energy-based devices may be used for many cutaneous indications, including facial resurfacing, improving skin conditions, and reducing signs of photoaging. Currently, no consensus papers or guidelines exist concerning peri-operative agents and specifically their use for laser skin resurfacing and their potential/possible role in prevention or treatment of side effects. AIM: To explore current practice using laser and energy devices, a survey was developed to identify the trends in pre- and postprocedural treatment measures. METHODS: The survey was sent out digitally to 300 randomly selected US dermatologist and plastic surgeon physicians practicing medical esthetics using laser and other energy devices treatment for facial rejuvenation. The survey gathered information on demographics, types of devices used in the clinic and pre-/postprocedural measures for facial laser, and other energy-based devices treatment. RESULTS: The survey was active from June 15, to July 15, 2018, and fifty-eight dermatologists and plastic surgeons completed the survey (19.3% response rate, 58/300). The results showed inconsistency in skin preparation strategies and postprocedure wound care. The majority of survey participants (55/58 [96%]) reported prophylactic oral antiviral use pre- and post-treatment; however, there was inconsistency about when to start and when to stop the use. A similar inconsistency existed in the recommended period of post-treatment sun protection before and after treatment. CONCLUSION: The results of the survey confirmed the lack of consistency in the types and duration of pre- and postprocedural measures-emphasizing the need for evidence-based recommendations to optimize outcomes, prevent infection, enhance comfort, and reduce downtime.

A Cohort Study Using a Facial Cleansing Brush With Acne Cleansing Brush Head and a Gel Cleanser in Subjects With Mild-to-Moderate Acne and Acne-Prone Skin

Introduction: Acne vulgaris is a highly prevalent skin condition that can adversely affect the quality of life. Acne-predisposed skin is in a state of subclinical inflammation leading to skin barrier dysfunction. A multi-center cohort study was designed to evaluate clinical efficacy and safety of twice daily facial cleansing using an oscillatory sonic brush, acne brush head, and cleansing gel for 4 weeks. Methods: Subjects with mild-to-moderate acne and acne-prone skin used the cleansing regime after which they applied the skin care products they routinely used. Physician-assessed skin condition comparing baseline versus week 4 using the FDA/IGA scale and subject satisfaction with cleansing efficacy and handling properties of the regime were scored during the last visit. Results: Forty-six subjects completed the study. Physician-scored skin condition showed a statistically significant improvement in FDA/IGA scores and a significant reduction of inflammatory and non-inflammatory lesions comparing baseline versus 4 weeks. Thirty-five (76.0%) subjects had cleared or almost cleared. Subjects similarly assessed their skin to be improved. Conclusion: Both the physician and subject scores revealed the gentle cleansing routine using the sonic brush to be effective reducing the number of acne lesions, improving skin condition. No adverse events were reported during the study period. The cleansing regime may offer an attractive, safe option for maintenance and treatment of subjects with mild-to-moderate acne and acne-prone skin. J Drugs Dermatol. 2019;18(11):1140-1145.

Current status of surgery in dermatology.

An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.

Satisfying patient expectations with soft-tissue augmentation.

The popularity of cosmetic procedures for rejuvenating the face has undergone enormous growth over the past few years, such that at least one in four cosmetic procedures involves the use of soft-tissue augmentation. Of note is the trend away from surgical interventions and toward noninvasive cosmetic procedures, which now account for the majority of all cosmetic procedures performed in the United States. Adult patients of all ages are selecting soft-tissue augmentation, either as a precursor to or a substitute for surgery; there is a trend toward the use of injectable devices in younger patients (aged 35 - 50 years). Patients in different age groups have diverse treatment needs ranging from the correction of fine lines and wrinkles in younger patients to volume restoration in older patients. Thus, the treatment needs will dictate the treatment approach, particularly with injectable filler treatments. The aesthetic physician needs to help the patient understand and select the most appropriate rejuvenating treatment based on a variety of factors, specifically, patient age, motivating factors, timing, cosmetic area to be addressed, and desired outcome. This article suggests a series of steps to help determine the most appropriate approach for volume restoration with injectable devices for satisfying patient treatment expectations.